GOP attacks Dems’ ‘California Schemin’ ’ on Medicare payments

First came the “Louisiana purchase” and the “Cornhusker
kickback” in the healthcare bill.

Now, Senate Republicans are taking aim at what they call a
“California Schemin’” provision buried in the $140 billion tax extenders bill.

California Democrats, as well as the state’s GOP governor, say it is needed to help counties deal
with paltry Medicare payments to doctors. It would increase Medicare payments
to doctors in California counties considered rural under Medicare’s payment
formula.

{mosads}These growing counties increasingly are becoming urban and
have seen healthcare costs skyrocket. The higher Medicare payments offered in
urban areas are needed to ensure hospitals can hire doctors to take care of
patients under Medicare, supporters of the provision said.

Sen. Tom Coburn, a conservative Oklahoma Republican, argues
that the provision is a wasteful special deal — an earmark — that unfairly
singles out one state for favorable treatment. The payments would cost $400
million over 10 years, according to the Congressional Budget Office.

“It has the appearance of a taxpayer-funded campaign subsidy
and, in the tradition of the ‘Cornhusker kickback,’ it unfairly singles out one
state for special treatment,” said John Hart, a spokesman for Coburn.

Cobun has offered an amendment to strike the measure from
the tax extenders bill.

The “Cornhusker kickback” provided increased Medicaid funding
to Nebraska and was included in the Senate’s healthcare bill to ensure Sen. Ben
Nelson’s (D-Neb.) support.

The Nebraska provision was criticized as a backroom deal by
Republicans and later removed at Nelson’s request.

The California provision was included in the House-passed
version of the tax extenders bill at the request of Rep. Sam Farr (D-Calif.).

Farr and Sen. Dianne Feinstein (D-Calif.) have long-backed
stand-alone legislation to increase Medicare reimbursement rates for California
counties, and Farr’s office dismissed Coburn’s amendment as election-year
politics.

Though Senate Republicans are seizing on Farr’s
measure as an earmark, the provision has support from some Golden State
Republicans in the House and Gov. Arnold Schwarzenegger (R).

The provision “would make Medicare
payments for these counties more equitable, and the Governor supports
California receiving its fair share from the federal government,” said
Rachel Arrezola, a spokeswoman for the governor.

Six GOP House members, including Reps. Duncan Hunter, Dana
Rohrabacher and Brian Bilbray, have joined with Democrats in either
co-sponsoring Farr’s bill or signing letters in support of the
increased doctor payments.

Farr spokesman Tom Mentzer said California counties have
waited 10 years to get the legislation.

“You have seniors who cannot find a Medicare physician,” he
added.

Mentzer acknowledged there are about 15 other states with areas that have
rising healthcare costs due to growth yet still get lower payments because
they’re considered rural by Medicare formulas. But he said California has as
many short-changed areas as the rest of the country combined.

The increase in payments for California counties could serve
as a “pilot program” to spur Medicare administrators to fix payment formulas
for other states, Mentzer said.